Nappy rash

[MeadowHay]

Please be gentle with me, DH and I are really upset about this atm and we need some constructive advice, ideally from people who work in this sector.

DD is 15 months, she's been in nursery 3 days a week since she was 9 months. In general we are happy with the nursery.

The only problem is nappy rash.

The last month or so though literally every week we send her to nursery with only a tiny bit of nappy rash and she comes home on Monday afternoon with a significant sore nappy area, that gets worse until Wed when is her last day. Then her nan has her and then we have her and the rash is almost gone by Monday. Then repeat. DH had a conversation with her keyworker about this a week ago and they gave us assurances about what they were doing and we agreed to trial using the wipes we use at home (although usually we just use cotton wool and water at home, we just use wipes when out or if she's done a poo). They use some kind of reusable wipes on her at nursery prior to this. The only things we could think of that were causing the rash was either these wipes, or not being changed quickly enough after doing a poo. Anyway they've been using our wipes and it's not made any difference. Today was the worst yet. She had a tiny bit of redness when I sent her in this morning and they didn't mention anything at pick up. We changed her for bed and she was screaming and flinching in pain, the entire area was BRIGHT red and she was so distressed she posseted as she'd not long had her bottle.

DH and I are so upset. I really don't want to take her tomorrow morning, I feel awful about it. The plan is that I ask them to do hourly changes tomorrow and stress how upset we are with her nappy rash after 1 day. And DH is going to call at lunchtime and see if we can schedule a meeting with the nursery manager for the end of the week that we will both attend. We are thinking of floating suggestions like checking her nappy every 30 mins or so (too much? not changing her just having a sniff/peek), keeping a record of who is doing the changes and when or assigning a specific staff member each day to be in charge of her nappies, asking that they let us know at collection if she has got bad nappy rash etc, providing cotton wool and asking them to just use water and cotton wool for changes...

Has anyone been in a similar situation, what did you do? Particularly keen to hear from nursery workers re how you would deal with this - I want to work with the nursery staff to find a solution to this. It is a fairly recent problem too, not something that's happened ever since she started.

[dementedpixie]

How is the nappy rash being treated? Is there cream for them to apply?

[TripleChocs]

What are you using to treat the nappy rash?Metanium Nappy Rash Ointment is brilliant, totally recommend.

[IVEgottheDECAF]

Are you providing cream? Metanium is the best

[MeadowHay]

Yes, so the nursery provide Sudocrem and we provide them with Metanium. DH clarified this with her keyworker the other week who confirmed they always apply Metanium at changes if she had nappy rash (which is all the time for the last month or so ). Sometimes when it's been particularly bad I have asked them specifically to use Metanium with a huge barrier of Sudocrem on top as GP and my relative who is a doctor both recommended that ages ago when she had that bad bout that got infected. But it seems they don't do that as standard, only if I ask, so I will ask them to do that when I drop her this morning. At home when she has it we just apply Metanium and if it's really bad we use both as above but that's only the case after she's been to nursery, she never has bad nappy rash like that if she's with us for any length of time.

[insancerre]

So they use the same tub of sudacream on all the children?
I would clarify that as it’s a perfect way to spread infections

[GeorgieTheGorgeousGoat]

I do too @insancerre but with a clean glove, no double dipping!

[MumUndone]

I only ever use wipes after a poo, never for just wee; but absolutely slather the whole area in sudocrem at every change, never had a problem with nappy rash - is it essential to use a wipe every change? Could this be making it worse?

[MeadowHay]

We don't use wipes every change, only when out or with poos, but in any event rarely had any problems with nappy rash that don't start at nursery. We just suggested to nursery to trial the wipes we use in case the resuable ones they use were the cause of it but as there's been no improvement then no point in continuing to do that. Hope that makes sense?

Don't know about Sudocrem but they do provide it. I think they use disposable gloves for changes though. I can find this out, DH has arranged a meeting for next week. But it's not infected though and we don't have a problem with infections, she only got an infection one time months and months ago and not since. It's just really red raw nappy area varying degrees of severity that always happens every week when she's in nursery then mostly clears up until she goes back on the Monday and it happens again etc.

[Red44]

Hiya, I’ve worked in nurseries a good few years. If I was you I would put my concerns in writing (email), include what you want to happen and what creams you want used and when/how, include in this for her to have a fresh nappy on before any naps. Request a meeting with the manager to discuss your concerns face to face. Ask for a record of when dd is changed and this should include what cream is being used. I would also provide labelled cream for your child only to ensure its being used. You can check weekly how much cream is being used. Ongoing nappy rash should be manageable in nursery. Asking for your child to be checked every 30mins/hourly is not unreasonable for a child with sore nappy rash. They should also be informing you daily if it’s got worse. Also I would recommend a gps visit maybe a different/stronger cream is needed. Hope it improves for you.

[birdybirdbird]

Could it be something to do with the gloves that they’re using when changing her? A latex allergy or similar that is irritating her skin, leading to nappy rash?

[MeadowHay]

Don't think it can be the gloves because the problem has become considerably worse just over the last month or so and I doubt they are using different gloves than in the past? But I can certainly raise it. We have a meeting with the nursery manager next week. So I am keeping note of all the things we want to raise with her otherwise I will forget. I feel it is hard because we do like and respect the staff in the baby room and I feel they think we are basically accusing them of not bothering to change her nappy promptly when she has done a poo. And they do seem in denial about the blatant pattern. Honestly DH said on Sunday night, we should take a photo of her nappy area and compare it to tomorrow evening after she's been in nursery and I said don't be daft and honestly it was so bad Monday evening we both cried and wished we had done it. But we shouldn't be in a position where we need photographic evidence surely?! The nursery have tried to deny it was bad yesterday which I think is odd. There's no possible way it suddenly got horrendous within 1.5hrs from collecting her from nursery and us changing her for bed.

Don't think it's worth a GP visit as it is only bad when she goes to nursery! Plus DH is a HCP too and agrees no clinical indications for a GP visit atm but appreciate the suggestion.

We do have a record of her nappy changes that is accessible to us and one of the concerns we raised the other week is that she is often doing multiple poos and these are increasingly logged at the normal nappy change times. Whereas months ago she would have poo changes logged at random times + the usual nappy changes they do for all of them at the same times each day. So it really looks to me that they are not changing her promptly after soiled nappies, that seems the most logical explanation. DH has spoke to her keyworker about this and she said that she gets changed if she has done a poo, but I don't believe she just happens to do a poo right before scheduled nappy change times so often?! And this makes sense too because months ago the poos were logged at random times and she didn't have the nappy rash all the time when she went to nursery then. There have been some staff changes in the room but not many and most of the staff involved in her care are still there, including her keyworker. Her keyworker has her own children and I would hate for her to think we are trying to say she doesn't know to change a soiled nappy promptly! But I can't think of any other explanation for this pattern of nappy rash.

[Geneva1995]

So my DD is 1.5 years old and attends nursery 3 full days a week and also gets nappy rash. Admittedly she gets it bad at home too, I think she is just super sensitive. I understand it’s difficult at nursery as they are so busy but her key worker is amazing and checks her nappy regularly. They upload onto an online portal every nappy change and they also make a record of when the metenium is applied which is good to know! Hope you get sorted love it’s bloody awful xxx

[Borderscotch]

Are you providing the nappies? Maybe the nursery brand isn't agreeing with her? Is she drinking enough, maybe her urine is stronger at nursery if she's not drinking. I was a nursery manager for 18 years, I would have been checking nappy changes myself, asking for staff initials so I could see if a pattern was occurring, monitoring fluid intake and using cotton wool and water only, and drying after. Other thoughts, are the menus very different than at home? Are they using more tomato based sauces for casseroles and stews? Maybe something on the menu disagrees with her? Ask them to log all ingredients and then you can see.

[CornishCreation]

It's easy to assume from the area that it's a nappy rash but could it be that she's not 100% dry after her bath as this is also known to cause a rash and naturally if she becomes sore then perhaps you or partner have not wanted to pat too dry in case to hurt her?

[june2007]

1 insist on water and cotton wool.
2 provide your own nappies or make sure the nursery is the same brand.
3 provide the cream and isist on barrier used on every change and metanium yello when there is rash.
4 Insist they change more regularly like every 2 hours.

[Confusedddd]

God I could have written this exact same thing myself , nappy rash horrendous by Friday but I manage to clear it up over the weekend then it’s back on Monday

[Tumbleweed101]

We’ve a little one prone to nappy rash at nursery. We use cotton wool and water to clean her, not wipes. She has cream applied each change and she is checked frequently for poo and changed promptly. She still flares easily but it’s mostly under control. We keep close contact with the parents about it. Obviously all changes are recorded and notes made if she’s looking like it might be getting sore so everyone knows.

[itsaboojum]

Have you considered the possibility you might be looking at the problem from the wrong end? Might it be an issue with diet rather than the details of nappy changes?

Something like squash or undiluted fruit juice or some other foodstuff can make a child’s urine very 'strong' and could irritate the skin.

[MeadowHay]

Tumble I wonder if you work in DD's room?!

I don't think it's diet, they eat a wide range of things at nursery and she does at home too. When I made the thread and was freaking out though, that turned out to be another infection that time which I wasn't happy about ofc but still explains why it looked so bad so quickly. Since that cleared up and we were discussing it a lot with nursery things have improved. She got a bit of rash last week again on her days in but not as bad as before and we have had a few weeks here and there where she hasn't got nappy rash from there. We had to cancel our meeting with them in the end and we haven't rearranged as the situation improved. But keeping a close eye on it all.

We have to provide our own nappies and we now also provide our own cotton wool and they use that and water. And they use Metanium (provided by us) if she has nappy rash + Sudocrem which they provide. We are thinking we will toilet train her once she is in the next room in the spring and it will remove this issue and also the fact that she goes ballistic when you try to change her.

I spoke to a friend IRl recently and her DC is in a different nursery and also only gets nappy rash from nursery. So seems like more common than I expected too which is sad. Apart from this I can't fault our nursery at all and DD loves the staff, she runs in and cuddles them.

[MeadowHay]

Also our nursery changes every 2 hours as standard which I think is actually overkill really if they're checking for poos. But my concern is that they're not checking for poos frequently enough. But looks like they're at least checking DD more now